Injections Flashcards
Advantages to injecting parenterally (4)
Emergency
Pt is unconscious
Localized drug therapy
Good for drugs that are degraded in the stomach
Downsides to injecting parenterally (2)
Must keep sterile field.
Once drug is injected, it cannot be retrieved
How to select the proper equipment (5)
Route ordered Viscosity How much medication Muscle mass/fat of patient Site of admin
The gauge of the needle is determined by the __ size
lumen
Gauge is inversely related to size
Which gauge needles are we using
Which syringe sizes are we using
Gauge: 20-27. Small.
1-5cc
Portions of equipment that should be kept sterile during preparation
Syringe- barrel, plunger, tip before needle is affixed.
needle
Main difference between vials and ampules
Vial contain single or multiple doses of meds. Rubber stopper that allows penetration of needle.
Ampules contains single dose of meds and cannot be reused. Must snap off top of ampule which can cause glass shards. Advised to use filter needle.
Sub Q
- The most __
- Good for what kind of meds
- not recommended for what meds
- What is the limiting factor
- Average length and gauge
- Location
- Location criteria
- The most versatile
- Good for meds that require slow absorption. Limited vascularity = slow absorption
- not recommended for thick or irritating meds
- Limiting factor is amount. Max 2ml.
- Average length is 5/6-1 inch and gauge 25-27
- Location: loose tissue of upper arm, anterior thigh, lower abdomen.
- Location criteria: Cannot be over bony prominence, free of large vessels and nerves, free of inflammation/itch/tender/edema/scar
Sub Q techniques
- Thin vs thick pts how to hold skin and angle of insertion
- Insert needle (quick or slow)
- Inject meds (quick or slow)
- Thin pt. Bunch the skin and insert at 45 degrees.
- Thick pt. Spread the skin. Insert at 90 degrees.
- Insert needle quick and inject slow while still holding the tissue.
- Apply pressure
IM
- What kind of meds?
- Average length and gauge
- site of injection
- Location criteria
- Onset of action
- Duration of effect
- Meds that cannot be given Sub q because either too irritating or large volume.
- Average length is 1-2 inches and gauge is 20-23
- site of injection: Deltoid of upper arm, vastus laterals (thigh) and gluteus maximus.
- Location criteria: Avoid adjacent nerves, bones and BV
- Onset of action: In between Sub q and IV
- Duration of effect: Long duration
IM techniques (2)
Air lock and Z track
What kind of meds should be injected IM Air lock
Non irritating meds.
What kind of meds should be injected IM Z track
Irritating meds or elderly patients with decreased muscle mass.
How to do IM airlock injection
Spread or bunch skin Insert quick at 72-90 degrees Release tissue Aspirate air to confirm not in BV Inject slowly Remove needle Apply pressure
How to do IM Z track injection
Spread or bunch skin Insert quick at 72-90 degrees Aspirate air to confirm not in BV Inject slowly while still holding tissue Remove needle Release tissue No pressure
IV
- What kind of meds and/or why
- Onset
- Average needle length, gauge and catheter
- Sites
- Which site is least painful
- If long term therapy ____
- Large vol of meds and emergency situations
- Onset is rapid
- Average needle length is 1 inch, gauge is 18-27 and catheter is 1-1.5 inch
- Sites: Antecubital, Dorsum of hand, forearm, foot.
- Which site is least painful. Antecubital but can be difficult in dark skin patients and diabetics.
- If long term therapy, start with distal site.
IV techniques
- Check vitals
- Tourniquet 2-6 inches above site
- Tell patient to clench hand or slap to make veins more visible. If this takes time, then reapply tourniquet.
- Attach butterfly needle
- Pull skin towards pt hand to prevent rolling.
- Needle bevel up
- Insert 15-45 degrees, then decrease angle and advance.
- Release tourniquet
- Inject slowly
- Firm pressure to prevent hematoma
Hands should be washed for how long
20 seconds before putting on gloves then after glove removal
Exposure to blood borne pathogens is most likely when
Using or handling sharp instruments such as hypodermic needles
Never should a needle be re capped after injection
True. Should be placed directly into sharps
Shaps container should be filled to ___ full
2/3
Tx chalazions
Sub Q injection of steroids
Sub conj or tenons injection of steroid to tx
Iritis, vitrifies, posterior uveitis.
IV steroids are the gold standards of
tx for optic neuritis
Side effects of steroids
Increase IOP
Cataract
Increase susceptible to infection
Decrease wound healing
Hyperglycemia
HTN
Osteoporosis
Fluid retention
INdocyanine
Alternative agent for fundus angiography.
Achieves better penetration of pigmented layers such as RPE and choroid.
Used to manage choroid disease- ARMD and tumors.
Adverse effects less severe than NaFl. nausea, vomiting, urticaria. Rarely anaphylaxis.
Should not be used on patient with shellfish or iodine allergy. Or pregnant/lactating mothers.
Benadryl can be injected how
IV or IM in response to allergic reaction
Epi can be injected
IM SQ or IV
